应用角膜地形图设计个性化白内障手术方案

目的：探讨如何在角膜地形图的指导下，设计个性化白内障手术方案，实现利用手术性散光矫正术前角膜散光，提高术后视觉质量，降低治疗费用的目的。

方法：将202例226眼白内障患者分成随机治疗组和个性化治疗组，在随机治疗组再按手术切口的类型和位置的不同分成8组，观察术前、术后角膜散光，通过矢量分析法计算出不同手术切口的手术性散光值。个性化治疗组的手术设计以随机治疗组的各手术性散光值为参考，并以术前角膜散光与手术性散光最接近的原则选择手术切口类型，切口位置在最陡子午线上，并观察个性化治疗组术后角膜散光。

结果：个性化治疗组术后角膜散光低于随机治疗组中3.0mm透明角膜隧道切口组，差异有统计学意义，与3.0mm巩膜隧道组无统计学差异，利用个性化手术方案55.8%患者可采用费用较为低廉的白内障囊外摘除加硬性人工晶状体植入术，可以降低人均治疗费用。

结论：应用角膜地形图设计个性化白内障手术方案可以矫正术前角膜散光，提高视觉质量，降低治疗费用。

Using corneal topography design personalized cataract surgery programs

AIM:To investigate how to design personalized cataract surgery programs to achieve surgical correction of preoperative corneal astigmatism with surgical astigmatism under the guidance of corneal topography, improve postoperative visual quality and reduce the cost of treatment.

METHODS: Totally 202 cases(226 eyes)cataract patients were divided into randomized treatment group and individualized treatment group. According to the method and location of the incision, randomized treatment group were divided into 8 groups. Surgical astigmatism after different incision were calculated with the use of preoperative and postoperative corneal astigmatism through vector analysis method. Individualized treatment groups were designed personably for surgical method with reference of every surgically induced astigmatism, the surgical method chooses the type of surgical incision based on close link between preoperative corneal astigmatism and surgically induced astigmatism, and the incision was located in the steep meridian. The postoperative corneal astigmatism of individualized treatment group was observed.

RESULTS: Postoperative corneal astigmatism of individualized treatment group were lower than that of 3.0mm clear corneal tunnel incision in the randomized treatment group, there were statistically significance difference, while with 3.0mm sclera tunnel incision group there were no statistically significance difference. After 55.8% of patients with the use of individualized surgical plan could undergo the operation of extracapsular cataract extraction with relatively low cost and rigid intraocular lens implantation, the per capita cost of treatment could be reduced.

CONCLUSION: Personalized cataract surgery programs are designed to achieve surgical correction of preoperative corneal astigmatism under the use of corneal topography, improve postoperative visual quality and reduce the cost of treatment.